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"This book is an edited version of the author's earlier published Ph.D. thesis, titled Barriers to Health Policy Liberalization in Canada: Institutions, Information, Interests and Incentives"--T.p. verso.
While Canadians are proud of their healthcare system, the reality is that it is fragmented and disorganized. Instead of a pan-Canadian system, it is a "system of systems" - thirteen provincial and territorial systems and a federal system. As a result, Canadian healthcare has not only become one of the costliest in the world, but is falling well behind many developed countries in terms of quality. Canadians increasingly realize that their healthcare system is no longer fiscally sustainable, yet change remains elusive. The standard claim is that Canada's multijurisdictional approach makes system-wide reform nearly impossible. Toward a Healthcare Strategy for Canadians disputes this reasoning, making the case for a comprehensive, system-wide, made-in-Canada healthcare strategy. It looks at the mechanics of change and suggests ways in which the various participants in the system - governments, healthcare professionals, the private sector, and patients - can work collaboratively to transform a second-rate system. Addressing critical issues of health human resources, electronic health records, integrated care, and pharmacare, Toward a Healthcare Strategy for Canadians shows how a system-wide strategic approach to this crucial policy area can make a difference in Canada’s healthcare system in the future.
A NATIONAL BESTSELLER SHORTLISTED FOR THE BALSILLIE PRIZE FOR PUBLIC POLICY It took the coronavirus pandemic to open our eyes to the deplorable state of so many of the nation's long-term care homes: the inhumane conditions, overworked and underpaid staff, and lack of oversight. In this timely new book, esteemed health reporter André Picard reveals the full extent of the crisis in eldercare, and offers an urgently needed prescription to fix a broken system. When COVID-19 spread through seniors' residences across Canada, the impact was horrific. Along with widespread illness and a devastating death toll, the situation exposed a decades-old crisis: the shocking systemic neglect towards our elders. Called in to provide emergency care in some of the hardest-hit facilities in Ontario and Quebec, the military issued damning reports of what they encountered. And yet, the failings that were exposed--unappetizing meals, infrequent baths, overmedication, physical abuse and inadequate personal care--have persisted for years in these institutions. In Neglected No More, André Picard takes a hard look at how we came to embrace mass institutionalization, and lays out what can and must be done to improve the state of care for our elders, a highly vulnerable population with complex needs and little ability to advocate for themselves. Picard shows that the entire eldercare system--fragmented, underfunded and unsupported--is long overdue for a fundamental rethink. We need to find ways to ensure seniors can age gracefully in the community for longer, with supportive home care and respite for family caregivers, and ensure that long-term care homes are not warehouses of isolation and neglect. Our elders deserve nothing less.
This book provides insight into how the Canadian health care system is financed and organized, how it has evolved over time, and how well it performs relative to peer countries.
Second in a series of publications from the Institute of Medicine's Quality of Health Care in America project Today's health care providers have more research findings and more technology available to them than ever before. Yet recent reports have raised serious doubts about the quality of health care in America. Crossing the Quality Chasm makes an urgent call for fundamental change to close the quality gap. This book recommends a sweeping redesign of the American health care system and provides overarching principles for specific direction for policymakers, health care leaders, clinicians, regulators, purchasers, and others. In this comprehensive volume the committee offers: A set of performance expectations for the 21st century health care system. A set of 10 new rules to guide patient-clinician relationships. A suggested organizing framework to better align the incentives inherent in payment and accountability with improvements in quality. Key steps to promote evidence-based practice and strengthen clinical information systems. Analyzing health care organizations as complex systems, Crossing the Quality Chasm also documents the causes of the quality gap, identifies current practices that impede quality care, and explores how systems approaches can be used to implement change.
Health care reform has dominated public discourse over the past several years, and the recent passage of the Affordable Care Act, rather than quell the rhetoric, has sparked even more debate. Donald A. Barr reviews the current structure of the American health care system, describing the historical and political contexts in which it developed and the core policy issues that continue to confront us today. This comprehensive analysis introduces the various organizations and institutions that make the U.S. health care system work—or fail to work, as the case may be. A principal message of the book is the seeming paradox of the quality of health care in this country—on the one hand it is the best medical care system in the world, on the other it is one of the worst among developed countries because of how it is organized. Barr introduces readers to broad cultural issues surrounding health care policy, such as access, affordability, and quality. He discusses specific elements of U.S. health care, including insurance, especially Medicare and Medicaid, the shift to for-profit managed care, the pharmaceutical industry, issues of long-term care, the plight of the uninsured, medical errors, and nursing shortages. The latest edition of this widely adopted text updates the description and discussion of key sectors of America’s health care system in light of the Affordable Care Act.
Health Promotion in Canada is a comprehensive profile of the history, current status, and future of health promotion in Canada. This fourth edition maintains the critical approach of the previous three editions but provides a current and in-depth analysis of theory, practice, policy, and research in Canada in relation to recent innovative approaches in health promotion. Thoroughly updated with 15 new chapters and all-new learning objectives, the edited collection contains contributions by prominent Canadian academics, researchers, and practitioners as well as an afterword by Ronald Labonté. The authors cover a broad range of topics including inequities in health, Indigenous communities and immigrants, mental health, violence against women, global ecological change, and globalization. The book also provides critical reflections on practice and concrete Canadian examples that bring theory to life.
During the last 25 years, life expectancy at age 50 in the United States has been rising, but at a slower pace than in many other high-income countries, such as Japan and Australia. This difference is particularly notable given that the United States spends more on health care than any other nation. Concerned about this divergence, the National Institute on Aging asked the National Research Council to examine evidence on its possible causes. According to Explaining Divergent Levels of Longevity in High-Income Countries, the nation's history of heavy smoking is a major reason why lifespans in the United States fall short of those in many other high-income nations. Evidence suggests that current obesity levels play a substantial part as well. The book reports that lack of universal access to health care in the U.S. also has increased mortality and reduced life expectancy, though this is a less significant factor for those over age 65 because of Medicare access. For the main causes of death at older ages-cancer and cardiovascular disease-available indicators do not suggest that the U.S. health care system is failing to prevent deaths that would be averted elsewhere. In fact, cancer detection and survival appear to be better in the U.S. than in most other high-income nations, and survival rates following a heart attack also are favorable. Explaining Divergent Levels of Longevity in High-Income Countries identifies many gaps in research. For instance, while lung cancer deaths are a reliable marker of the damage from smoking, no clear-cut marker exists for obesity, physical inactivity, social integration, or other risks considered in this book. Moreover, evaluation of these risk factors is based on observational studies, which-unlike randomized controlled trials-are subject to many biases.
The world has undergone a revolution in assisted reproduction, as processes such as in vitro fertilization, embryonic screening, and surrogacy have become commonplace. Yet when governments attempt to regulate this field, they have not always been successful. Canada is a case in point: six years after the federal government created comprehensive legislation, the Supreme Court of Canada struck it down for violating provincial authority over health. In Assisted Reproduction Policy in Canada, Dave Snow provides the first historical exploration of Canadian assisted reproduction policy, from the 1989 creation of the Royal Commission on New Reproductive Technologies to the present day. Snow argues the federal government’s policy failure can be traced to its contradictory "policy framing," which sent mixed messages about the purposes of the legislation. In light of the federal government’s diminished role, Snow examines how other institutions have made policy in this emerging field. Snow finds provincial governments, medical organizations, and even courts have engaged in considerable policymaking, particularly with respect to surrogacy, parentage, and clinical intervention. The result—a complex field of overlapping and often conflicting policies—paints a fascinating portrait of different political actors and institutions working together. Accessibly written yet comprehensive in scope, Assisted Reproduction Policy in Canada highlights how paying attention to multiple policymakers can improve our knowledge of health care regulation.
The total U.S. civilian non-institutionalized population in 2009 was estimated to be slightly more than 301 million, of whom 15.1 per cent or 45.5 million, were estimated by the American Community Survey to be without health insurance or uninsured. The uninsured are far more likely than those with health insurance to report problems getting needed medical care, less likely to follow recommended treatments because of costs, have less access to care, receive less preventive care, and are more likely to be hospitalized for avoidable health problems. Moreover, it is widely believed that the uninsured, when they need care, are less able to pay for their care since they do not have health insurance. Therefore, it also can be further assumed that other payers take on the financial burden of their care through higher prices. This book examines the plight of the uninsured in the United States today, by State and Congressional District.